在上，则尺不应。南政之岁，三阴在天，则寸不应；三阴在泉，则尺不应，右左同。
一申用药不远寒热之律 （律一条 发明《内经》一条） 凡治病，用寒远寒，用热远热，其常也。不远寒热，
其变也。若不知常变，一概施治，酿患无穷，医之罪也。
发表不远热，攻里不远寒。不发不攻，而犯寒犯热，寒热内贼。其病益甚。故不远热则热至，不远寒则寒至，寒至
则坚否、腹满、痛急下利之病生矣。热至则身热、吐下、霍乱、痈疽、疮疡、瞀郁、注下、 、肿胀、呕、鼽衄、骨
节变、肉痛、血溢、血泄、淋 之病生矣。
治病惟发表不远热，非发表则必远热矣。惟攻里不远寒，非攻里则必远寒矣。不当远而远，当远而不远，其害俱不
可胜言。
一申治病不知约方之律 （律一条 发明《内经》二条） 凡用方，不分君臣佐使，头绪纷杂，率意妄施，药
与病迥不相当，医之罪也。
约方，犹约囊也。囊满弗约，则输泄。方成弗约，则神与弗居。
业医者，当约治病之方，而约之以求精也。《易》曰∶精义入神，以致用也，不得其精，焉能入神？有方无约，即无
神也，故曰神与弗居。藏位有高下，府气有远近，病证有表里，用药有轻重。调其多少，和其紧慢，令药气至病所，故
为勿太过与不及，乃为能约。
未满而知约之可为工，不可以为天下师。
未满而知约，何约之有？是以言约者，非满不可，故未满而知约，必不学无术之下材耳。然较诸全不知约者，失必
稍轻。尝见用峻剂重剂之医，屡获奇中；及征其冥报，比用平剂、轻剂者转厉，岂非功以幸邀，不敌罪耶？噫！安
得正行无间之哲，履险皆平，从权皆经也哉？
一申治病不知约药之律 （律一条 发明《内经》二条） 凡用药太过不及，皆非适中，而不及尚可加治，太
过则病去药存，为害更烈，医之过也。
帝曰∶有毒无毒，服有约乎？岐伯曰∶病有久新，方有大小，有毒无毒，固宜常制矣。大毒治病，十去其六；常毒
治病，十去其七；中毒治病，十去其八；无毒治病，十去其九；谷肉果菜，食养尽之，无使过之，伤其正也。
下品烈毒之药治病，十去其六即止药；中品药毒次于下品治病，十去其七即止药；上品药毒，毒之小者，病去其八
即止药；上下中品，悉有无毒平药，病去其九即当止药，此常制也。
有毒无毒，所治为主，适大小为制也。
但能破积愈疾，解急脱死，则为良方。非必以先毒为是，后毒为非，无毒为非∶有毒为是，必量病轻重大小而制其
方也。《周礼》令医人采毒药以供医事，以无毒之药可以养生，不可以胜病耳。今世医人通弊，择用几十种无毒之药，
求免过愆。病之二三，且不能去，操养痈之术，坐误时日，迁延毙人者比比，而欲己身长享，子孙长年，其可得乎？
一申治病不疏五过之律 （律一条 释《经》文五条） 凡诊病，不问三常，不知比类，不察神志，不遵圣训，
故犯无忌，医之过也。
凡未诊病者，必问尝贵后贱，虽不中邪，病从内生，名曰脱营。尝富后贫，名曰失精。五气留连，病有所并。粗工
诊之，不在脏腑，不变形躯，诊之而疑，不知病名。身体日减，气虚无精，病深无气，洒洒然时惊病深者，以其外耗于
卫，内夺于营，良工所失，不知病情，此亦治之一过也。
过在不问病情之所始也。
凡欲诊病者，必问饮食居处。暴乐暴苦，始乐后苦，皆伤精气，精气竭绝，形体毁沮，暴怒伤阴，暴喜伤阳，厥气
上行，满脉去形。愚医治之，不知补泻，不知病情，精华日夺，邪气乃并，此治之二过也。
过在不知病患七情所受，各不同也。
善为脉者，必以比类奇恒，从容知之。为工而不知道，此诊之不足贵，此治之三过也。
比类之法，医之所贵。如老吏判案，律所不载者，比例断之，纤悉莫逃也。奇恒者，审其病之奇异平常也。从容者，
凡用比类之法，分别病能。必从容参酌，恶粗疏简略也。
诊有三常，必问贵贱，封君伤败，及欲侯王，故贵脱势，虽不中邪，精神内伤，身必败亡。始富后贫，虽不中邪，
皮焦筋屈，痿 为挛。医不能严，不能动神，外示柔弱，乱至失常，病不能服，则医事不行，此治之四过也。
此过繇于不能戒严病者，令之怀然神动，蠲除忧患，徒外示柔弱，委曲从人也。
凡诊者，必知终始，有知绪余。切脉问名，当合男女，离绝菀结，忧恐喜怒，五脏空虚，五气离守，工不能知，何
术之语？
察气色之终始，知病发之余绪。辨男女之顺脉，与七情内伤，故离间亲爱者魂游；绝念所怀者意丧；菀积所虑者神
劳；结固余怨者志苦；忧愁者闭塞而不行；恐惧者荡惮而失守；盛怒者迷惑而不治；喜乐者惮散而不藏。由是八
者，故五脏空虚，血气离守，工不思晓，又何言医？
尝富大伤，斩筋绝脉，身体复行，令泽不息，故伤败结，留薄归阳，脓积寒热。粗工治之，亟夺阴阳，身体解散，
四肢转筋，死日有期，医不能明，不问所发，惟言死日，亦为粗工，此治之五过也。
非分过损，身体虽复，津液不滋；血气内结，留而不去，薄于阳脉，则化为脓；久积腹中，则外为寒热也。不但不
学无术者为粗工，即使备尽三世经法，而诊不辨三尝，疗不慎五过。亦为粗略之医也。
凡此五者，受术不通，人事不明也。
一申治病不征四失之律 （律一条 明录经文二条） 凡治病，不问证辨脉，而以无师之术笼人，此最可贱，
不足罪也。
夫经脉十二，络脉三百六十五，此皆人之所明知，工之所循用也，所以不十全者，精神不颛，志意不理，外内相失，
故时疑殆。
精神不颛，不能吉凶同患。志意不理，不能应变无穷。内外相失，不能参合色脉，安得不疑而且殆？
诊不辨阴阳，此治之一失也。受师不卒，妄作杂术，谬言为道，更名自功，妄用砭石，后遗身殃，此治之二失也，
不适贫富贵贱之居，坐之浓薄，形之寒温，不适饮食之宜，不别人之勇怯，不知比类，足以自乱，不足以自明，此治之
三失也。诊病不问其始，忧患饮食之失节，起居之过度，或伤于毒，不先言此，卒持寸口，何病能中？妄言作名，为粗
所穷，此治之四失也。
位于上部（寸口脉），则尺部脉搏不应指。在南政之年，若三阴经司天，则寸口脉搏不应指；若三阴经在泉，则尺部脉搏不应指，左右手情况相同。
第二条：申明用药不远离寒热属性的法则 （一条法则 发明《内经》一条） 凡是治病，使用寒性药要避开寒邪盛时，使用热性药要避开热邪盛时，这是常规。不远离寒热属性，这是变通之法。如果不懂得常与变的区别，一概而论地施治，酿成无穷祸患，是医生的罪过。
发表（解表散邪）不远离热性药，攻里（泻下积滞）不远离寒性药。如果不进行发表或攻里，反而触犯寒热之邪，导致寒热内侵贼害脏腑。病情就会更加严重。所以，不远离热性药则热邪至，不远离寒性药则寒邪至。寒邪至，则产生坚硬痞塞、腹部胀满、疼痛急迫、腹泻等病证。热邪至，则产生身体发热、呕吐泄泻、霍乱、痈疽、疮疡、神志昏蒙郁结、痢疾不止、皮肤黑斑、肿胀、呕吐、鼻塞流涕及鼻出血、骨节变形、肌肉疼痛、血液溢出、便血、淋证等病证。
治病只有发表时才不远离热性药，如果不是为了发表，就必须远离热性药。只有攻里时才不远离寒性药，如果不是为了攻里，就必须远离寒性药。应当远离而远离，或者应当不远离而不远离，其危害都不可胜言。
第三条：申明治病不知精简方剂的法则 （一条法则 发明《内经》二条） 凡是开方，不分君臣佐使的主次关系，头绪杂乱，随意妄加药物，药性与病情完全不相适应，是医生的罪过。
精简方剂，就像收紧口袋一样。口袋满了如果不收紧，内容物就会泄漏。方剂形成了如果不精简，神灵（药效的精微作用）就不会驻留其中。
从事医学的人，应当精简治病的方剂，并通过精简来求得精妙。《易经》说：“精研义理进入神妙境界，以达到应用的目的。”得不到精妙，怎么能进入神妙境界？有方剂而没有精简，就没有神灵驻留，所以说“神灵不会驻留”。脏腑位置有高下之分，腑气运行有远近之别，病证有表里之异，用药有轻重之别。调节药物的多少，调和药性的缓急，使药气到达病所，做到不过分也不不足，这才叫作“约”（精简）。
在药味未满数时就懂得精简，可以称为工匠，但不能作为天下的老师。
在药味未满数时就懂得精简，有什么可精简的呢？所以说讲求精简，并非药味多到一定程度不可行。因此，在药味未满时就懂得精简的，必定是不学无术的下等人才。然而，比起完全不知道精简的人来，过失必然稍轻一些。我曾见过使用峻烈药剂和沉重药剂的医生，屡次获得奇效；等到考察他们的因果报应时，发现比使用平和药剂、轻浅药剂的医生遭受的惩罚更严厉，这难道不是功劳出于侥幸，抵不过罪过吗？唉！哪里能得到行为端正无瑕疵的哲人，履险如夷，权变皆合于经义呢？
第四条：申明治病不知精简药物的法则 （一条法则 发明《内经》二条） 凡是用药太过或不及，都不是适中，而不及还可以再加治疗，太过则病去而药存，造成的危害更猛烈，是医生的过错。
黄帝问：“有毒和无毒的药物，服用时有精简的原则吗？”岐伯答：“疾病有久有新，方剂有大有小，有毒无毒，本来就有固定的制度。用大毒药物治疗，病去十分之六就停药；常用毒性的药物治疗，病去十分之七就停药；中等毒性的药物治疗，病去十分之八就停药；无毒药物治疗，病去十分之九就停药；用谷肉果菜进行食养来彻底清除余邪，不要使治疗过度，以免损伤正气。”
下品烈毒的药物治病，病去十分之六就停止用药；中品药物毒性次于下品，治病病去十分之七就停止用药；上品药物毒性较小者，病去十分之八就停止用药；上、下、中三品中都有无毒平和的药物，病去十分之九就应当停止用药，这是常规制度。
有毒无毒，以所治疗的疾病为主，根据病情大小来制定剂量。
只要能破除积聚、治愈疾病、解除危急、挽救死亡，就是良方。不一定认为先有毒的是对的，后无毒的是错的，或者认为无毒的是错的、有毒的是对的；必须衡量病情的轻重和大小区制方剂。《周礼》命令医官采集毒药以供医疗事务，是因为无毒的药物可以用来养生，但不能用来战胜重病。当今世上的医生普遍弊病在于，选择使用几十种无毒的药物，以求避免过失。对于两三成的病，尚且不能去除，拿着养护痈疽（比喻姑息养奸）的技术，坐视延误时日，拖延致人死亡的情况比比皆是，还想让自己长寿，子孙长年安康，怎么可能呢？
第五条：申明治病不列举五种过失的法则 （一条法则 解释《内经》经文五条） 凡是诊病，不问患者的三种常态（贵贱、贫富、始富后贫等），不知道运用比类法，不察知患者神志变化，不遵循圣人的训诫，肆意犯忌，是医生的过错。
凡是未诊病之前，必须询问患者曾经尊贵后来卑贱的经历，即使没有感受外邪，病也从内生发，名叫脱营。曾经富裕后来贫穷，名叫失精。五脏之气留连不去，病邪相互合并。粗疏的医生诊断时，认为不在脏腑病变，形体躯干也没有变化，诊断时心存疑虑，不知道病名。患者身体日渐消瘦，气虚无精，病深入而无气，时时感到洒洒然惊恐。病深入的，是因为外在耗损卫气，内在剥夺营气。高明的医生也会失误，因为不了解病情，这也是治疗的第一个过失。
过失在于不问病情起始的原因。
凡是想要诊病的人，必须询问饮食起居状况。突然快乐突然痛苦，开始快乐后来痛苦，都会损伤精气，精气枯竭断绝，形体毁坏沮丧。暴怒伤阴，暴喜伤阳，厥逆之气上行，充满经脉，脱离形体。愚笨的医生治疗时，不知道补泻，不了解病情，精华日益被掠夺，邪气于是并合，这是治疗的第二个过失。
过失在于不知道病患受七情影响各不相同。
善于切脉的人，一定运用比类和奇恒（异常）的方法，从容不迫地了解病情。作为医生如果不懂这个道理，这种诊断就不值得珍贵，这是治疗的第三个过失。
比类的方法，是医生所珍视的。就像老练的官吏判案，法律条文没有记载的，通过类比推理来判决，细微之处都不会遗漏。奇恒，是审察疾病的奇异与平常之处。从容，是凡是用比类方法时，分别病机能力，必须从容参酌，厌恶粗疏简略。
诊病有三常，必须询问贵贱经历。封君受损败落，以及想成为侯王而未得，所以尊贵之人失去权势，即使没有感受外邪，精神内伤，身体必然败亡。开始富裕后来贫穷，即使没有感受外邪，也会皮焦筋屈，痿软为挛缩。医生如果不能严肃对待，不能打动患者心神，外表示以柔弱，导致诊疗秩序混乱失常，病不能服，那么医疗事务就无法推行，这是治疗的第四个过失。
这个过失源于不能告诫患者严肃对待，使其心怀敬畏、精神感动，消除忧患，只是外表示以柔弱，委曲顺从他人。
凡是诊病的人，必须知道疾病的终始，了解有余的病绪。切脉问诊，应当结合男女差异，区分离间、绝念、郁结、忧恐喜怒等情绪，导致五脏空虚，五气离散守位，医生如果不能知晓，说什么医术呢？
察看病色的终始，知道发病的余绪。辨别男女顺脉，以及七情内伤，所以离间亲爱之情者魂游荡；断绝所怀念头者意志丧；郁积所思虑者神劳倦；固结剩余怨恨者志苦闷；忧愁者气闭塞而不行；恐惧者心荡惮而失守；盛怒者神迷惑而不治；喜乐者神惮散而不藏。由这八种情况，导致五脏空虚，血气离散守位，医生如果不思晓悟，又谈什么医学呢？
曾经富裕受到大伤，斩断筋脉，身体虽然恢复行动，但津液滋润功能不息止，所以伤败凝结，留滞薄归于阳分，脓积形成寒热证。粗疏的医生治疗，急于夺阴阳平衡，导致身体解散，四肢转筋，死期有定数，医生不能明察，不问发病原因，只说死期，也是粗疏的医生，这是治疗的第五个过失。
非分外的过损耗伤，身体虽然恢复，但津液不滋润；血气内结，留滞不去，薄于阳脉，则化为脓；久积腹中，则外表现为寒热证。不仅是不学无术的人是粗疏的医生，即使备尽三世经法，而诊病不辨别三常，治疗不慎防五过，也是粗略的医生。
以上这五种情况，都是医术不通达，人事不明白的缘故。
第六条：申明治病不考证四种过失的法则 （一条法则 明录经文二条） 凡是治病，不问症状辨别脉象，却用没有师承的技艺欺骗人，这是最可鄙贱的，不值得怪罪。
十二经脉，三百六十五络脉，这些都是人所熟知的，医生所遵循使用的。之所以不能十全十美，是因为精神不专一，志意不理顺，内外相失，所以时常疑惑危险。
精神不专一，不能共同承担吉凶（即无法准确判断预后）。志意不理顺，不能应对无穷的变化。内外相失，不能参合色脉，怎么能不疑惑而且危险呢？
诊病不辨别阴阳，这是治疗的第一个过失。接受师教没有完成，胡乱杂用各种技艺，谬误之言当作大道，更改名称自夸功效，妄用砭石，留下后患殃及自身，这是治疗的第二个过失。不适应贫富贵贱的居住环境，坐卧的浓淡厚薄，形体的寒温，不适应饮食的适宜，不分辨人的勇敢怯懦，不知道比类法，足以使自己混乱，不足以使自己明白，这是治疗的第三个过失。诊病不问疾病起始，忧患、饮食失节、起居过度，或伤于毒物，不先说明这些，突然持取寸口脉，能诊出什么病？妄言命名，被粗疏所困穷，这是治疗的第四个过失。
In the upper position (Cun), the Chi pulse does not respond. In years of Nan Zheng (Southern Polity), if the Three Yin meridians govern the Heaven (San Tian), the Cun pulse does not respond; if the Three Yin meridians govern the Earth (Zai Quan), the Chi pulse does not respond, and this applies to both left and right hands equally.
Article 2: Clarifying the Law that Medication Should Not Distantly Avoid Cold or Heat (One Law, Expounding One Passage from *Nei Jing*) Generally, in treating diseases, one should avoid using cold medicines during cold periods and hot medicines during hot periods; this is the constant rule. Not avoiding cold or heat constitutes a variable approach. If one does not understand the distinction between the constant and the variable, and treats all cases uniformly, it will brew endless disasters; this is the fault of the physician.
To release the exterior (Biao) does not require distancing oneself from heat; to attack the interior (Li) does not require distancing oneself from cold. If one neither releases the exterior nor attacks the interior, but instead exposes the patient to cold or heat, causing cold and heat to invade internally as thieves, the disease will worsen. Therefore, if one does not distance oneself from heat, heat will arrive; if one does not distance oneself from cold, cold will arrive. When cold arrives, diseases such as hardness and obstruction, abdominal fullness, urgent pain, and diarrhea arise. When heat arrives, diseases such as fever, vomiting and diarrhea, cholera-like disorders, carbuncles and sores, mental confusion and depression, dysentery with continuous discharge, black spots on the skin, swelling, vomiting, nasal congestion with epistaxis, deformation of bone joints, muscle pain, hemorrhage, bloody stool, and strangury arise.
In treating diseases, only when releasing the exterior does one not distance oneself from heat; otherwise, one must distance oneself from heat. Only when attacking the interior does one not distance oneself from cold; otherwise, one must distance oneself from cold. To distance oneself when one should not, or not to distance oneself when one should, results in harms that are beyond description.
Article 3: Clarifying the Law Regarding the Failure to Simplify Prescriptions (One Law, Expounding Two Passages from *Nei Jing*) Whenever prescribing, if the roles of Sovereign (Jun), Minister (Chen), Assistant (Zuo), and Courier (Shi) are not distinguished, resulting in chaotic complexity, and drugs are arbitrarily added, making the medication completely mismatched with the disease, this is the fault of the physician.
Simplifying a prescription is like tightening a bag. If a full bag is not tightened, its contents will leak. If a prescription is formed but not simplified, the divine efficacy (Shen) will not reside within it.
Practitioners of medicine should simplify prescriptions for treating diseases and achieve refinement through simplification. The *I Ching* states: "Penetrating the meaning leads to spiritual profundity, thereby enabling application." Without obtaining refinement, how can one enter spiritual profundity? Having a prescription without simplification means there is no divine efficacy residing in it; hence it is said that "the divine does not reside." Zang organs have high and low positions, Fu organ qi has distances near and far, disease patterns have exterior and interior distinctions, and medication has heavy and light properties. Adjusting the quantity and harmonizing the speed and slackness ensures the medicinal qi reaches the disease site. Thus, avoiding excess and deficiency constitutes "simplification" (Yue).
Knowing how to simplify before the number of herbs is full qualifies one as a craftsman, but not as a teacher for the world.
What is there to simplify if the number of herbs is not yet full? Therefore, speaking of simplification implies that it is not feasible unless the prescription is full. Consequently, those who know how to simplify when the prescription is not full are likely unlearned and incompetent individuals. However, compared to those who do not know simplification at all, their errors are slightly less severe. I have observed physicians using potent and heavy formulas who frequently achieved miraculous cures; yet, upon examining their karmic retribution, they suffered harsher consequences than those using mild and light formulas. Is this not because their merit was accidental, failing to outweigh their fault? Alas! Where can one find a wise person of upright conduct without flaw, who walks safely on dangerous paths and whose adaptive measures always conform to canonical principles?
Article 4: Clarifying the Law Regarding the Failure to Simplify Medications (One Law, Expounding Two Passages from *Nei Jing*) Using medication excessively or insufficiently is never moderate. Insufficiency can be corrected by adding treatment, but excess leaves residual drug action after the disease is gone, causing more severe harm; this is the physician's error.
The Yellow Emperor asked: "For toxic and non-toxic drugs, is there a principle of limitation?" Qibo answered: "Diseases vary in duration and novelty, and formulas vary in size. There is a fixed system for toxic and non-toxic drugs. For drugs with major toxicity, stop when six-tenths of the disease is removed; for drugs with common toxicity, stop when seven-tenths is removed; for drugs with moderate toxicity, stop when eight-tenths is removed; for non-toxic drugs, stop when nine-tenths is removed. Use grains, meats, fruits, and vegetables for dietary nourishment to complete the recovery. Do not overdo it, lest you injure the healthy Qi."
Drugs of the Lower Grade with fierce toxicity should be stopped when six-tenths of the disease is removed; drugs of the Middle Grade, with toxicity inferior to the Lower Grade, should be stopped when seven-tenths is removed; drugs of the Upper Grade with minor toxicity should be stopped when eight-tenths is removed. Among the Upper, Lower, and Middle Grades, there are all non-toxic and mild drugs, which should be stopped when nine-tenths of the disease is removed. This is the standard system.
The use of toxic or non-toxic drugs depends primarily on the disease being treated, and dosages are determined according to the severity and size of the condition.
A good formula is one that can break up accumulations, cure diseases, resolve emergencies, and save lives from death. It is not necessarily true that having toxicity first is correct and non-toxicity later is wrong, or that non-toxicity is wrong and toxicity is correct. One must measure the severity and size of the disease to formulate accordingly. The *Rites of Zhou* ordered medical officers to collect toxic drugs for medical affairs, indicating that non-toxic drugs can be used for health preservation but are insufficient to overcome serious diseases. A common malpractice among contemporary physicians is selecting dozens of non-toxic drugs to avoid blame. Such approaches fail to eliminate even two or three parts of the disease. They employ techniques akin to nurturing an abscess, sitting idle while wasting time, delaying until patients die—a situation seen everywhere. How can they expect themselves to live long and their descendants to enjoy longevity?
Article 5: Clarifying the Law Regarding the Failure to Enumerate Five Errors (One Law, Explaining Five Passages from the Classic) In diagnosing diseases, failing to inquire about the Three Constants (social status changes), not knowing how to use analogical reasoning, failing to observe the patient's spirit and mind, and disregarding sage teachings, acting recklessly without fear, constitute the physician's fault.
Before diagnosing, one must ask about past experiences of nobility followed by baseness. Even without external pathogenic invasion, disease arises internally, named Tuoying (Depletion of Ying). Past wealth followed by poverty is named Shijing (Loss of Jing). The Five Qi remain stagnant, and pathogens merge. Crude physicians diagnose, believing the issue lies neither in the Zang-Fu nor in physical deformity, feeling doubtful and unable to name the disease. The body wastes away daily, Qi becomes deficient and Jing depleted. The disease deepens without Qi, accompanied by shivering and sudden fright. Deep disease results from external depletion of Wei Qi and internal deprivation of Ying Qi. Even skilled physicians may err due to lack of understanding of the condition; this is the first error in treatment.
The error lies in not asking about the origin of the condition.
When intending to diagnose, one must ask about diet and living conditions. Sudden joy followed by sudden sorrow, or initial joy turning to sorrow, all damage Essence-Qi. When Essence-Qi is exhausted and destroyed, the physical form deteriorates. Sudden anger injures Yin, sudden joy injures Yang. Rebellious Qi ascends, filling the vessels and separating from the form. Foolish physicians treat without knowing tonification or sedation, lacking understanding of the condition. The essence is daily stolen, and evil Qi merges. This is the second error in treatment.
The error lies in not knowing that patients suffer from the Seven Emotions differently.
Those skilled in pulse diagnosis must use analogical reasoning and comparison with abnormal states (Qiheng), understanding calmly and deliberately. A practitioner who lacks this knowledge renders diagnosis worthless; this is the third error in treatment.
Analogical reasoning is highly valued by physicians. Like an experienced judge handling cases not covered by law, one uses analogy to decide, leaving no detail unexamined. "Qiheng" refers to examining whether the disease is abnormal or ordinary. "Congrong" means carefully considering and comparing when using analogical methods to distinguish pathological mechanisms, avoiding carelessness and brevity.
Diagnosis involves the Three Constants: one must ask about noble/base status. Loss of power after being a feudal lord, or failure to become a king, causes spiritual injury even without external pathogens, leading to bodily decline. Poverty after wealth causes dry skin and contracted sinews, leading to flaccidity and spasms. If the physician cannot be strict, cannot move the patient's spirit, and shows outward weakness, the treatment order becomes chaotic, the disease remains untreatable, and medical practice fails. This is the fourth error in treatment.
This error stems from the inability to admonish the patient seriously, inspire reverence and spiritual movement, remove worries, and merely showing outward weakness while yielding to others.
Physicians must know the beginning and end of diseases and understand residual symptoms. Pulse taking and inquiry must consider gender differences. Separation, divorce, frustration, worry, fear, anger, and joy cause the Five Zang to become empty and the Five Qi to leave their posts. If the physician does not understand this, what talk of medical skill is there?
Observing the beginning and end of Qi and color reveals residual symptoms of onset. Differentiating normal pulses in men and women, and internal injuries from the Seven Emotions: separation from loved ones causes the Hun (Ethereal Soul) to wander; cutting off desires causes the Yi (Intellect) to be lost; accumulated worries exhaust the Shen (Spirit); lingering resentment causes bitterness in the Zhi (Will); sorrow causes obstruction and stagnation; fear causes instability and loss of control; rage causes confusion and disorder; excessive joy causes dispersion and lack of storage. From these eight factors, the Five Zang become empty, and Blood and Qi leave their posts. If the physician does not reflect and understand, how can they speak of medicine?
Great injury from former wealth severs sinews and vessels. Although the body regains movement, the moistening function does not cease. Injury and collapse condense, lingering and attaching to Yang, forming pus and alternating chills and fever. Crude physicians treat hastily, disrupting Yin and Yang, causing the body to disintegrate, limbs to spasm, and death to come soon. Physicians who cannot clarify this, do not ask about the onset, and only predict death are crude doctors. This is the fifth error in treatment.
Non-proportional damage restores the body, but fluids are not nourished. Internal knotting of Blood and Qi lingers and does not dissipate. Attaching to Yang vessels transforms into pus; lingering in the abdomen manifests externally as alternating chills and fever. Not only are the unlearned considered crude physicians, but even those who master the classics of three generations, yet fail to distinguish the Three Constants in diagnosis and do not guard against the Five Errors in treatment, are also considered rough practitioners.
All five errors stem from incomplete mastery of skills and ignorance of human affairs.
Article 6: Clarifying the Law Regarding the Failure to Verify Four Errors (One Law, Recording Two Passages from the Text) Treating diseases without distinguishing symptoms and pulses, and deceiving people with unorthodox methods lacking proper lineage, is the most despicable and hardly worthy of blame.
The twelve meridians and three hundred sixty-five collaterals are well-known to everyone and followed by practitioners. The reason for not achieving perfect success is lack of spiritual focus, unruly intent, and disconnect between internal and external states, leading to doubt and danger.
Lack of spiritual focus prevents sharing in fortune and misfortune (accurate prognosis). Unruly intent prevents responding to infinite changes. Disconnect between internal and external prevents integrating complexion and pulse analysis. How can one avoid doubt and danger?
Failing to distinguish Yin and Yang in diagnosis is the first error in treatment. Failing to complete apprenticeship, practicing random eclectic arts, presenting fallacies as Dao, changing names to claim credit, and recklessly using Bian stones, leaving subsequent harm to the body, is the second error in treatment. Failing to adapt to the living conditions of the poor, rich, and noble; the thickness or thinness of seating; the cold or warmth of the physique; and the suitability of diet; failing to distinguish bravery from timidity; and not knowing analogical reasoning, leads to self-confusion rather than self-clarity. This is the third error in treatment. Failing to ask about the onset of disease, including worries, dietary irregularities, excessive lifestyle, or toxic injuries, and suddenly palpating the Cun Kou pulse without prior context, allows one to diagnose nothing. Making wild claims and names, becoming trapped by crudeness, is the fourth error in treatment.